银屑病关节炎的中轴病变：银屑病关节炎队列中单侧 2 级骶髂关节炎的存在和进展。
Axial Disease in Psoriatic arthritis: The presence and progression of unilateral grade 2 sacroiliitis in a psoriatic arthritis cohort.
机构信息
Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Carmel and Lin Medical Centers, Haifa, Israel.
Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
出版信息
Semin Arthritis Rheum. 2021 Apr;51(2):464-468. doi: 10.1016/j.semarthrit.2021.03.007. Epub 2021 Mar 20.
BACKGROUND/PURPOSE: A universally accepted definition of axial psoriatic arthritis (axPsA) is lacking. We aimed to 1) assess the presence of axial involvement as defined by "at least unilateral grade 2 sacroiliitis (Uni2SI)" and 2) assess the radiographic progression of Uni2SI and identify risk factors for progression.
METHODS
PsA patients participating in a prospective observational cohort were classified according to their highest sacroiliitis grade. The baseline features of patients with Uni2SI were compared to patients meeting the radiographic criteria of the modified New York Ankylosing Spondylitis (mNY AS) criteria. Risk factors were examined for progression from Uni2SI in a sub-group of patients with >1 follow-up radiographs. Logistic regression and a survival analysis were carried out and identified risk factors associated with radiographic mNY AS compared to Uni2SI.
RESULTS
Axial disease defined as ≥Uni2SI was detected in 612/1354 patients (45%). mNY AS sacroiliitis was observed in 477 patients (35%). Radiographic progression of Uni2SI was assessed in 154 patients, 80 (52%) progressed to mNY AS criteria within 5.5 years. At baseline, progressors were diagnosed at a younger age (35.6 vs. 38.9, p = 0.05), had less degenerative disc disease (OR = 0.47, p = 0.02), worse peripheral radiographic damage (OR=1.02, p = 0.03) and worse psoriasis (OR = 1.09, p = 0.01) compared to non-progressors. Patients with an elevated erythrocyte sedimentation rate were more likely to progress (HR = 1.83, p = 0.02), while patients with longer disease duration were less likely to progress (HR = 0.95, p = 0.02).
CONCLUSION
The radiographic mNY AS criteria appear to be suitable for defining axial PsA according to radiographs. MRI definitions are needed as well for the most appropriate definition of axial PsA.
背景/目的：目前缺乏对轴性银屑病关节炎（axPsA）的通用定义。我们旨在：1）评估“至少单侧 2 级骶髂关节炎（Uni2SI）”定义的轴性受累情况；2）评估 Uni2SI 的放射学进展并确定进展的危险因素。
方法
参与前瞻性观察队列的 PsA 患者根据其最高骶髂关节炎分级进行分类。比较 Uni2SI 患者的基线特征与符合改良纽约强直性脊柱炎（mNY AS）标准的放射学标准的患者。对具有>1 次随访影像学检查的患者亚组进行进展的危险因素检查。进行逻辑回归和生存分析，确定与放射学 mNY AS 相比与 Uni2SI 相关的危险因素。
结果
在 1354 例患者中，有 612 例（45%）患者诊断为≥Uni2SI 的轴性疾病。477 例患者（35%）被诊断为 mNY AS 骶髂关节炎。对 154 例患者进行了 Uni2SI 的放射学进展评估，其中 80 例（52%）在 5.5 年内进展为 mNY AS 标准。在基线时，进展者的诊断年龄更小（35.6 岁 vs. 38.9 岁，p=0.05），退行性椎间盘疾病较少（OR=0.47，p=0.02），周围放射学损害更严重（OR=1.02，p=0.03），银屑病更严重（OR=1.09，p=0.01）。红细胞沉降率升高的患者更有可能进展（HR=1.83，p=0.02），而疾病持续时间较长的患者不太可能进展（HR=0.95，p=0.02）。
结论
放射学 mNY AS 标准似乎适用于根据影像学结果定义轴性 PsA。还需要 MRI 定义，以获得对轴性 PsA 的最恰当定义。
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